Definition

The repair or removal of an aneurysm, which is a weakened, abnormal outpouching within the wall of the aorta. The aorta is the body's largest artery, which originates in the heart and has many branches to deliver blood throughout the body.

Parts of the Body Involved

The aorta:

  • Seventy-five percent of aortic aneurysms involve the part of the aorta that passes through the abdomen (abdominal aortic aneurysms)
  • Twenty-five percent of aortic aneurysms involve the part of the aorta that passes through the chest (thoracic aortic aneurysms)

Reasons for Procedure

  • To prevent rupture of an aneurysm, which would cause severe, life-threatening bleeding
  • To remove a ruptured aneurysm and repair the damaged aorta

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your physician will likely do some or all of the following:

  • Physical exam
  • Blood tests
  • X-rays—a test that uses radiation to take pictures of structures inside the body
  • Ultrasound—a test that uses sound waves to find the aneurysm
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
  • MRI scan—a test that uses magnetic waves to make pictures of the inside of the body
  • Cardiac catheterization—the insertion of a tube-like instrument into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply
  • Electrocardiogram—a test that records the heart's activity by measuring electrical currents through the heart muscle

In the days leading up to your procedure:

  • The night before, eat a light meal and do not eat or drink anything after midnight.
  • You may be given laxatives and/or an enema to clean out your intestines.
  • You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use.
  • Arrange for help at home after returning from the hospital.
  • Arrange for a ride to and from the procedure.

During Procedure

  • IV fluids
  • Sedation
  • Anesthesia
  • A breathing tube will be used during surgery, but will be removed when you begin to awaken from the anesthetic.
  • You may require a tube through your nose and into your stomach to remove accumulated stomach acid and fluids.
  • You may require a catheter in your bladder until a few hours after the operation is completed.

Anesthesia

General

Description of the Procedure

Depending on the exact location of the aneurysm, blood flow may need to be diverted to a heart-lung machine, which will temporarily do the jobs of providing the blood with oxygen and circulating the blood through your body.

The surgeon makes an incision in the abdomen or chest, over the area of the aneurysm. The aorta is clamped above and below the aneurysm. The surgeon opens the aneurysm, cleans out any debris, and then sews a dacron tube (graft) in place to reconnect the two ends of the aorta. The tissue of the aneurysm is then wrapped around the outside of the graft.

When the graft is properly in place, the clamps are released, allowing blood flow to resume through the aorta. The incision is closed, using either stitches or staples, and covered with a sterile dressing.

Repair of Abdominal Aortic Aneurysm

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After Procedure

You'll need to stay in the intensive care unit for the first day or so after surgery so that your vital signs can be carefully and continuously monitored; you'll then be moved to a regular hospital room.

How Long Will It Take?

About one hour

Will It Hurt?

Anesthesia prevents pain during surgery.

Possible Complications

  • Severe bleeding
  • Kidney failure
  • Respiratory distress
  • Heart attack
  • Stroke
  • Infection
  • Tissue death—If blood circulation is cut off to the limbs or intestines, these tissues could be deprived of oxygen, leading to tissue death.
  • Damage to nerves in the area, leading to sexual problems (such as impotence)
  • Blood clots and complications if these blood clots break off and travel through the circulatory system
  • Death

The chance for complications is greatly increased when the operation is done on an emergency, rather than a planned, basis.

Average Hospital Stay

4-7 days

Postoperative Care

Monitoring Your Condition

You'll be hooked up to monitors to track your heart rate, breathing, blood pressure, and blood oxygen levels for the first day or two after surgery. Also, your surgeon may order blood tests, chest x-rays, EKG, and ultrasound of the repaired area of the aorta.

Dealing With Nausea

You may be nauseated for a few hours after surgery. Depending on various factors, your surgeon may have placed a nasogastric tube through your nose and into your stomach to drain accumulated fluids and stomach acid. You won't be able to eat or drink until this is removed and you're no longer nauseated, so you'll continue to receive fluids and sugar through an IV. Once you begin eating, you may need to eat a lighter, blander diet than usual.

Preventing Blood Clots

You may be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.

Improving Lung Function

You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, in order to improve lung function after general anesthesia.

Outcome

Recovery takes about six weeks. If you had symptoms from your aneurysm before the surgery, you may notice some improvements in your health, such as more strength and less swelling in your legs, lower blood pressure, improved energy, and absence of pain from the aneurysm.

Call Your Doctor If Any of the Following Occurs

  • Swelling or pain in your abdomen
  • Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Signs of infection, including fever and chills
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
  • Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain